CMS recently updated its guidance on Specialized Services to clarify that Specialized Services can only be provided while individuals reside in nursing facilities. States are obligated to provide or arrange for the disability-specific services that individuals need while in NFs.
There is a common misconception about this. The simple answer is "no" -- a test of intllectual functioning is not required. Here's the reasoning, broken down into its components:
Oversight responsibility for Level I screens rests with the state Medicaid agency, although all involved parties are eligible to conduct the Level I screens, including nursing facilities, the state mental health authority, the state intellectual disability authority, or an independent entity (such...
Yes, hospitals can perform Level II evaluations -- provided they have the qualified staff. In order to complete these evaluations, hospitals would first have to negotiate payment rates with the relevant state agency.
The hospital discharge exemption is the only true exemption from the requirements of PASRR. The exemption applies to individuals who are discharged from a hospital into a Medicaid-certified nursing facility (NF) and their stay is expected to last no more than 30 days.
The July 2013 PASRR webinar took place on Tuesday, July 9 at 1PM Eastern (10AM Pacific) and featured Dr. Ed Kako, Director of the PASRR Technical Asisstance Center (PTAC) and Dan Timmel, PASRR policy director at the Centers for Medicare and Medicaid Services.
The Level I evaluation is the preliminary screen that identifies suspected intellectual disability, mental illness, or a related condition. The Level I screen is a vital “gatekeeper” to the process of identifying disability-specific needs and evaluating appropriate placement.
The CFR does not prescribe a particular method of conducting Level I evaluations, leaving states open to their own interpretations. In general, the Level I evaluation is based on pre-existing information, such as prior mental health diagnoses, and information gathered by the screener.
A PASRR Level I evaluation must be completed for all applicants to a Medicaid-certified nursing facility, regardless of payer. A Level I screen must be completed before a resident can be admitted into a nursing facility.
Claims for PASRR activities are submitted by the Single State Medicaid Agency to CMS on a quarterly basis via Form CMS-64.
Lines 10 and 11 of Form CMS-64 are used to claim the enhanced 75% match rate for PASRR-related activities. Specifically, a state should use line 10 to claim its “Preadmission Screenings Costs,” i.e. PASRR activities that happen before admission into a nursing facility.
Claiming the enhanced 75% match rate for PASRR-related activities means more than just completing Form CMS-64. States must also consider the following:
Only the share of time spent on PASRR-related activities can be claimed at the enhanced 75% match.
The Division of Cost Allocation (DCA) within the Program Support Center (PSC) approves states’ CAPs.
Any activity that cannot be clearly tied to the administration of PASRR cannot be claimed at the enhanced 75% match. Examples include, but are not limited to:
CMS generally reimburses nursing facility level of care (NF LOC) determinations at the 50% match rate. However, states that integrate their NF LOC determination activities with PASRR as described below can receive the enhanced 75% match rate.
A Cost Allocation Plan (CAP) is a narrative description of the procedures that a state will use in identifying, measuring, and allocating costs that it incurs in supporting programs it administers or supervises.
Activities that can be clearly tied to the administration of PASRR, and in accordance with the Cost Allocation Plan, can be claimed at the enhanced 75% match. Examples include, but are not limited to:
A resident review (RR) and determination must be conducted promptly (within an average of 7-9 days) after a nursing facility has notified the state mental health authority or state intellectual disability authority that there has been a significant change in the resident’s physical or mental...